2018 Network Contracting Congress

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Monday, February 26, 2018 ∙ 5:30 p.m. – 7:30 p.m.
Implementing an Effective Network Strategy: Optimizing Your Health Plan's Largest Asset

This workshop session will examine:
• New CMS Regulatory Guidance
• Building a Network Monitoring Process
• Developing a network strategy to foster overall growth Provider Payment Innovation as a Path to Provider Collaboration

About the Workshop Leader:
Elena Martin is Senior Director of Provider Innovations at Gorman Health Group (GHG). In this role, she has acted as Project Manager for numerous network expansion projects on a national level and has been a key consultant in Accountable Care Organization (ACO) and End-Stage Renal Disease Seamless Care Organizations (ESCO) application and development. Elena brings GHG clients more than 20 years of experience as a healthcare executive with a strong focus in all aspects of project management, sales, contracts and provider network development. In addition, she has extensive experience in hospital and physician contracting, governance and implementation, marketing, customer service training programs and human resources. Elena has worked for and held management positions for leading emergency medicine management companies and commercial, Medicare, and Medicaid health plans.

As a provider network manager for a regional health plan offering commercial and Medicare plans, Elena was responsible for managing a territory with 45,000 member lives and over 1,000 providers including, hospitals, skilled nursing facilities, physicians and ancillary providers. In this role, she was also responsible for ensuring National Committee for Quality Assurance (NCQA) and governmental compliance for the provider network region. Elena’s expertise includes managed care contracting on behalf of providers, including tertiary care hospitals, ancillary providers, Physician-Hospital Organizations (PHOs), and universities. Additionally, consulting with the solo and group practice, established and start up physician organizations, provider networks, third-party administrators, healthcare facilities, and employers’ access, as well as expertise to navigate through their managed care contracting, credentialing, and reimbursement issues.

Tuesday, February 27, 2018 ∙ 12:45 p.m. – 2:45 p.m.
Sand Traps, Mouse Traps, and Bear Traps: How to Effectively Manage the Regulatory Risks of Provider Network Evolution  

As health plans evolve toward tighter, better integrated provider networks focused on high value providers, they face increasingly formidable regulation. Depending upon the market - Commercial, Medicaid, Medicare Advantage – health plans face new requirements for network adequacy, provider directory accuracy, notice for midyear network changes, care transitions, cultural competence among network providers, and more.

In this workshop, participants will "war game" a set of common provider network management scenarios, and fully consider the regulatory implications of each.    

About the Workshop Leader:
Michael Adelberg is a Principal at FaegreBD Consulting in Washington, D.C. He has 25 years of progressive experience with Medicare, Medicaid and the Health Insurance Exchanges that provide health care coverage for well over 100 million Americans. Before joining Faegre Baker Daniels Consulting, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO). In these roles, Mike was responsible for setting policy and implementing critical Affordable Care Act operations in multiple areas, including health plan management, eligibility and enrollment, the small-business health options program (SHOP), and the Co-Op loans. While in CCIIO, Mike led a team of 125 staff and oversaw a $300 million annual operating budget.

In his prior years at CMS, he was director of Medicare Advantage operations, leading monitoring of MA contractors. In both CMS roles, Mr. Adelberg was responsible for setting CMS’s network-adequacy policy and the oversight of provider networks. As Vice President for Product Development and consultant to health plans, Mr. Adelberg has, among many other things, helped negotiate provider contracts with strategic and preferred providers. He has published and spoken about provider network oversight several times in trade magazines and at national conferences.